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Home My WebLink About01-0840 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS LI"~/. ~m Estate of Antoinette Williams also known as J enn i e R. Will i ams No. , Deceased Social Security No. 178 - 28 -1483 Lillian P. Rowland and Joann M. Para Petitionens), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) rn A. Probate and Grant of Letters Testamentary and aver that Petitionens) is/are the execut r ices named in the last Will of the Decedent, dated 03/10/1993 and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: none D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 48 Strawberry Drive, Boro of Carlisle, Carlisle, FA 17013 (list street, number, and municipality) Decedent, then ~years of age, died 06/11/2001 at Harrisburg Hospital, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania $ $ $ $ q~;) D~ D I [)y" e6J b s~ualed as follows </Ss' -S~ k".~ br. Wherefore, Petitioner(s) respectfully request(s) the pro ate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a riate form to the undersi ned: T ed or rinted name and residence Lillian P. Rowland 205 Acre Drive, Carlisle, PA 17013 Joann M. Para 8812 Fort Drive, Manassas, VA 20110 17-1&,- '1 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland before me this if ~ day of .~MAJ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. ~~Q~ Lillian P. Rowl~ .'---- g~n7~~ ann M. Para Sworn to or affirmed and subscribed , ~I No. 21-01-840 Estate of Antoinette Williams A/K/ A JENNIE R. WILLIAMS Deceased Social Security No; 178 - 28 -1483 Date of Death; 06/11/2001 AND NOW, SEPTEMBER 11 , 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters []] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Lillian P. Rowland and Joann M. Para in the above estate and that the instrument(s) dated 03/10/1993 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES 1..ffh1t2. JI1~~~' ~ (!. tJ.~7;A.tJ {)",("/~ ' or ' Register of Wills / (\~ ~ ~-, Attorn\j James D. Flo'";;er, & 1.0. No; 27742 Saidis, Shuff, Flower & Lindsay Address; 2109 Market Street Letters. . . . . . . $ 235.00 Short Certificate(s). $ 9 . 00 Renu nciation. $ Affidavits ( $ Extra Pages ( 2 ). $ 6. 00 Camp Hill, FA 17011 Codicil. . $ 5.00 Telephone: 717/737-3405 JCP Fee. $ Inventory. $ Other . . $ TOTAL. $ 255.00 CALLED ATTORNEY SEPT 12, 2001 Form RW-1 (1991) Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. , -'c:. ~r_,; ":,'"":\. "'':(~ This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fillllg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. JI1,~~~ Fee for this certificate, $2.00 Local Registrar p 7543085 JUN 13 2001 Date Hl0S.143 Aev. 2117 COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH IT n K NAME Of DECEDENT If.... _. L_, 1. JENNIE WILLIAMS UNDER 1 YEAR MorahI Dave STAlE FILE NU_R SEX SOCIAL SECURITY NUMBER J. FEMALE 3. 178 - 28 - 1483 PI.ACI OF DEATH IO><<l< croy.,.,. _......_cn__l HOSPITAL: OTHER: .....- at ::::e IUoRITAL SW\JS._ .............,. ~ Oiloon:ed jSpoody) 14. Wid ow 1711.0....__.. ~IO RACE '_-'IIIIcII. WI\lIe.__ (SpeaIy1 10. Whi te SUlMYlNG SPOUSE (r_.___1 ... NONE Did - ..... . ---.,? ...... Carlisle . r_".l 21e.Mother of Sorrows Cem214.Greenfeild Twp,PA HAME ANOADORESSOF ~ ~.JW SCOTCHLAS FH,Inc 621 Ma~n impson LICENSE NUMBER IAjlpIoJ_ PilRTI: !=-~ I : ! : WERE AIJlOPSY FINDlNG$ ~ PftIORlO COUPlETlON Of CAUSE OfF 0EAfH'l MANNER Of DEATH _0 NoD ......... -.. ~ ur" o o DATE OF INJURY llolonln. Day. _I liME Of INJUAY INJUAY AT WORK? IlESCIlIBE /'fCNV INJlIAY OCCURRED. - o o o PlACE Of INJURY. "'home. tann. _. tac:Io<y. _. Ill. ~ .....ISpeoIvI -. _ 0 NoD P-..a~"'" I s;-s-;r;z-a. Could.... lMIdel_ - c:sn1l'1ER.0-.. croy OM) "CI!IlTIl'VING PHYSICIAN (PlIrsoc- cOf1ol\on9 cause d- <lelllh _ anah.. ph""",,*, I1a$ pronouncecl <lealll ano COII1IlIONd II8In 23) To__e'...'___.----"'11lol~MI.)and---.. ................................................... a. "1'fI(IHC)IINaNG AND c:eIITII'Y_ PHYSICIIUl (Pl\ySICtan bolt: P/0tl0U1lClIIg <lealll and cOt1Jlytng 10 <:au... 01 de_1II1 lO.... _ of ..., _...... _ _ ar.... _. da... _ plac.. and _10 .... ......e., and m......'.. ""lId.. . . . . . . . . . . . . . . . . . . . . . . . . OIlEDlCAl. EXAMlHERlCORONER On'" baaie of e._lion an4I_ in....llgAlion. in m, opinion. dearh occuned "'hellme. d.'.. and plac., and d~ 10"" cau..,.) and .......... .. -..... . . . . .. . . . . . . . .. . . . . . .. . .. . . . . . . . . .. .. . . .. . . . .. . . . .. . .. . . . .. . .. . . . . .. .. .. . . .. . .. .. . . . .. .. .. .. .. . . 11a. ! " 21-01-840 3Ects! lIi11 ctUb QrtS!cttmU! OF ANTOINETTE WILLIAMS a/k/a JENNIE R. WILLIAMS I. Antoinette Williams a/k/a Jennie R. Williams, of 603 Reservoir Street, Simpson, Lackawanna County, Pennsylvania, being of sound mind and body, declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils. FIRST: I direct the payment of all of my just debts, funeral and testamentary expenses as soon as convenient after my decease. SECOND: I give, devise and bequeath all of my property, both real and personal, in equal per stirpes shares, to Lillian P. Rowland and Joann M. Para. However, it is also my expressed desire that both of the heirs give an equal monetary amount to each of my grandchildren as a token of my love for each of them. THIRD: I appoint Lillian P. Rowland and Joann M. Para as Co-Executrices and I direct that they not be required to post bond. I further direct that in the case of specific devises and/or bequests, any inheritance tax due on said specific bequest shall be the responsibility of said beneficiary and shall not be paid from the residuary account. Further, I specifically authorize and empower my executor to convey any and all realty that may be devised and distribute the proceeds to the named beneficiary and/or beneficiaries. This does not exclude said executor from devising the realty to the named beneficiary but allows him extra discretionary power to convey and/or sell. Ii I _ t I Commonwealth of Pennsylvania County of I, Antoinette Williams, a/k/a Jennie R. Williams, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will, that I signed it willingly; and that I signed it as my tree and voluntary act for the purposes therein expressed. .~ ~ r;G~-JA~I~ ~~ ~/;-?1A 4-~ ANTOINETTE WILLIAMS a/k/a /~, <' ~ ./. . ~~ < y ----,I.J ' W--,,/ ~ .-r~ rYNNIE R. WILLIAMS Sworn or affirmed to and acknowledged before me by Antoinette -+h Williams, a/k/a Jennie R. Williams, Testatrix, this 10 day of rY\Clrc \\ , 1993 We, E- ./ ( . . !~rv.- )1-7. J 'LLA-~' I NOTARY , and Notarial Seal Donna Shema. Noay Public Forest CIty Boro, Susquehanna ~ My Commission Expires Apr1l27. 1006 the Witnesses, whose names are signed to the attached or instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. fr:C7\ ~t~h, /~ WI?~..S.' ~. 77~' WITNESS Sworn or ~firmed to above Wi tnesses, ~t1.. '^- .......'" V\r\' this ID day of It \oJLch. and subscribed to b\fore me by the 'h~cL r~a(\w ~ NotariaiSeal~ Donna Shema, Notary Public ForestClty.~,~C01 My Canriissm ~ .~"iI27, 1:r Member, PennsYlVania Association IN WITNESS WHEREOF, I hereunto set my hand and seal this 4h Ib day of m aJ\ch Nineteen Hundred and Ninety Three (1993). C?~~7d~~ ANTOINETTE WILLIAMS a/k/a . ; . ~7 d . \~. UJ/fl.jlA~ i3"tNNIE R. WILLIAMS SIGNED, SEALED, PUBLISHED AND DECLARED by Antoinette Williams a/k/a Jennie R. Williams, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses: AT I? K J li.iU-1~L-iA J 6.- I ~L/~/ AT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FLOWER JAMES D JR 26 WEST HIGH STREET CARLISLE, PA 17013 _n_____ fold ESTATE INFORMATION: SSN: 1 78-28-1483 FILE NUMBER: 21-2001- 0840 DECEDENT NAME: WILLIAMS ANTOINETTE DA TE OF PAYMENT: 09/11/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/11/2001 NO. CD 000252 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8,350.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: LILLIAN P ROWLAND CHECK# 1451 SEAL INITIALS: CW RECEIVED BY: $8,350.00 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ()/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jennie R. Williams Date of Death: June 11, 2001 Will No. 21-01-0840 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: complete: 1 . Yes State X ; whether No administration of the estate is 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Within next three months - after income tax returns have been prepared and filed. 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes ; No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes~; No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ;----....... re Date: sftc;/JY , t c~ \..,'1 Capacity: Personal Representative r'J p X Counsel for Personal Representative 'I. r ':" -'" ........ ~ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Jennie R. Williams Date of Death: June 11, 2001 Will No. 21-01-0840 Admin. No. To the Register: I certify that notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on September j.\, 2001. Name Address Lillian P. Rowland Joann M. Para Glenn K. Rosborough John A. Rosborough Robert W. Rosborough Richard W. Rosborough Sandra L. Rosborough Sheryl A. Behr John W. Para, II R. Joseph Para Lynn R. Para Lisa M. Toth Lori A. Para 205 Acre Drive, Carlisle, P A 17013 8812 Fort Drive, Manassas, VA 20110 385 Mooredale Rd., Carlisle, PA 17013 149 Fieldstone Dr., Carlisle, PA 17013 3834 Dorset Dr., Mechanicsburg, P A 17055 30 Deer Run Rd., Durham, CT 06422 2708 Woodridge Rd., Champaign, IL 61822 1500 Marlton Rd., Mechanicsburg, P A 17050 8812 Fort Dr., Manassas, VA 20110 8747 Weems Rd., Manassas, VA 20110 1806 Ridge Rd., Haymarket, VA 20169 11910 Cowne Ct., Nokesville, VA 20181 8812 Fort Dr., Manassas, VA 20110 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: 9k-t/o' es D. Flower, Jr., E qui e West High Street Carlisle, P A 17013 (717) 243-6222 Capacity: _ Personal Representative ----X- Counsel for Personal Representative 1'7-6- ~. '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX lATE ESTATE OF DATE OF DEATH FILE NUMBER P 2 t!oONTY ACN .02 ~1AR 1 8 JAMES D FLOWER JR SAIDIS ETAL 2109 MARKET ST Cieri CAMP HILL PA 17011.{ltl8SX, 03-11-2002 WILLIAMS 06-11-2001 21 01-0840 CUMBERLAND 101 * REY-1547 EX AFP CDl-02) ANTOl NETT Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=is4-j-ix--AF,,--fol-:ozi--Norici--oF-'rtiHiifiTAifcE-'~fAx-jrpPRAisii'-ENT~--ALi-oWANCE-ifR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WILLIAMS ANTOl NETT FILE NO. 21 01-0840 ACN 101 DATE 03-11-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION C~NCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 1081000.00 .00 .00 .00 11547.00 931143.05 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: 17,822.44 653.36 (11) (12) (13) (14) (9) (10) .00 X 00 = 184,214.25 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, submit the upper portion of this forll with your tax paYllent. 202,690.05 18.475 80 184,214.25 .00 184,214.25 (19)= .00 8,289.64 .00 .00 8,289.64 TAX CREDITS: . "'. ......., "........., , {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-11-2001 CDOO0252 414.48 8,350.00 TOTAL TAX CREDIT 8,764.48 BALANCE OF TAX DUE 474.84CR INTEREST AND PEN. .00 TOTAL DUE 474.84CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A --CREDIT-- (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \, /7-6-~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REY-1U7 EX AFP (ol-D2) '02 i\PR 29 r 3 ::~ 2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-08-2002 WILLIAMS 06-11-2001 21 01-0840 CUMBERLAND 101 ANTOl NETT JAMES D FLOWER JR SAIDIS ETAL 2109 MARKET ST ~".. c CAMP HI L L P A~tit'-Olo1: Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =ii;o-j-Ex--AFP--foi-:021-------...--iNirERI,.-ANci--YAX--STA-fEMENY-ifF"-Accouiif--...---------------- ----- ESTATE OF WILLIAMS ANTOINETT FILE NO. 21 01-0840 ACN 101 DATE 04-08-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-04-2002 P R I NCI PAL TAX DU E : ..",....."."""...."."""....."""""........".""".""....""....,.........""""........_......'''......"......''''''..............''''...''''''..............''''''.,...,.,...."..".."..".....,.. 8,289.64 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-11-2001 CDOO0252 414.48 8,350.00 03-22-2002 REFUND .00 474.84- TOTAL TAX CREDIT 8,289.64 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 .. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) c . .. OFFICIAL USE ONLY REV~ 1500 EX. (6-00) REV-1500 /7- 6- b INHERITANCE TAX RETURN FILE NUMBER COMMONWEAL TH OF PENNSYLVANIA 21-01-0840 DEPARTMENT OF REVENUE RESIDENT DECEDENT DEPT. 260601 HARRISBURG. PA 17126-0601 COUNTY CODE YEAR NUMBER 0 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER E Williams Antoinette 178-28-1483 C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE ALED IN DUPUCATE WITH THE E 0 06/11/2001 04/21/1911 REGISTER OF WILLS E N (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER T ~ 1. Original Return 2. Supplemental Return B 3. . (date of death I-- Remamder Return prior to 12-13-82) CAPB 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required HpRL 'X I-- 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 S. Total Number of Safe Deposit Boxes EplO - '-- - CRAC (Attach copy of Will) (Attach copy of Trust) KOTK 09, 010. 0 11. Election to tax under Sec. 9113(A) ES Litigation Proceeds Received Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) (Attach Sch O) THISSECTIONMUSTBECOMPLETED~ALLCORRESPO,NDENCE&.CONFIDEN17IAL TAXINFORJ\.4ATION,SHOUI..D BE DIRECTED TO: p NAME COMPLETE MAILING ADDRESS C 0 0 James D. Flower, Jr. R N FiRM NAME ;If Applicable) 2109 Market R 0 St. E E Saidis, Shuff, Flower & Lindsav Camp Hill, PA 17011 S N T TELEPHONE NUMBER ....,..... ...J~.-:: :::u 717/737-3405 .- {f.~ P :Om -- 1. Real Estate (Schedule A) (1) 108,000.WO OFFICIALVSS ONL Y 2. Stocks and Bonds (Schedule B) (2) None '- = 3. Closely Held Corporation, Partnership or (3) None z N Sole - Proprietorship I.,Q 4. Mortgages & Notes Receivable (Schedule D) (4) None (5) 1,547.00 v R 5. Cash, Bank Deposits & Miscellaneous Personal Property i"J E (Schedule E) C i' \..,,~ A 6. Jointly Owned Property (Schedule F) (6) 93,143.05 N P 0 I Separate Billing Requested T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L (Schedule G or U A Total Gross Assets (total Lines 1-7) (S) 202,690.05 T 8. I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17 ,822.44 0 N 10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10) 653.36 11. Total Deductions (total Lines 9 & 10) (11) 18,475.80 12. Net Value of Estate (Line 8 minus Line 11) (12) 184,214.25 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 184,214.25 C SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0 M T P 15. Amount of Line 14 taxable at the spousal tax U A T rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (1S) 0.00 X A 16. Amount of Line 14 taxable at lineal rate 184,214.25 X .0 45 (16) 8,289.64 T I 17. Amount of Line 14 taxable at sibling rate X 12 (17) 0.00 0 N 18. Amount of Line 14 taxable at collateral rate X .15 (1S) 0.00 19. Tax Due (19) 8,289.64 20. fXl 1.~-=Il;J(;.f,II$a-=jllfiXq~jAa~J!~,~~QE;$T'''~j'Aij~E;~~gj:>'ffi;~i~~fleAY"'~T;.i1 >>.'BE.SURETOANSWEFliALL QUESTIONS ON FlEVEaSESJDE "NDTORECa~CKJ\.4ATJol.<< Copyright (c) 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS . 48 Strawberry Drive CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 8,7. 51.64 0.00 8,350.00 41~. :"8 Total Credits ( A + B + C) (2) 8,/ 6 'f. it' '5 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WillS, AGENT 0.00 471- 84 0.00 0.00 0.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" 1. Did decedent make a transfer and: a. retain the use or income of the property transferred: b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . d. receive the promise for life of either payments. benefits or care? 2. If death occurred after December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. !~~$~!g:~~~~:8~.~'I~+g..~~~~k~'!W: Yes No ~~ D D D [R] [R] [R] U!"Ide" pe~3:I~ies "f ~er:l...l~/, 1 declare th=.t ~ ha..'e o;.{:.:-:~::,,:;::d ~hi::: ietuin. ;ncluc:i1g acc:ornpai-,Y;i1g ~dl.::~\Jj~':) and stai.t'lm~ms. cmd \0 the best or my Knowieage and oeirer. it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~ (._J. J' .~/ I i .,.~ Lt-,-'" {/.-.r ~_ '-c.~ j , SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE .\ I ,\ For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent. or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2) [72 PS. 9116(a)( 1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV -1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Antoinette Williams SS# 178-28-1483 06/11/2001 21-01-0840 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with riQht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 48 Strawberry Drive, Borough of Carlisle, Cumberland County 108,000.00 (sale price - see settlement sheet attached) SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1. Recapitulation) $ 108,000.00 (If more space is needed. insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1502 EX (Rev. 1-97) REV-1508 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Antoinette Williams SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSfj 178-28-1483 06/11/2001 FILE NUMBER 21-01-0840 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Household goods and furnishings (based on attached appraisal) VALUE AT DATE OF DEATH 1,547.00 .. TOTAL (Also enter on line 5, Recapitulation) $ 1,547.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) , ~ REV -1509 EX + (1-97) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Antoinette Williams SCHEDULE F JOINTLY-OWNED PROPERTY SSff 178-28-1483 06/11/2001 FILE NUMBER 21-01-0840 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Lillian P. Rowland ADDRESS 205 Acre Dr. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT daughter B. Joann M. Para 8812 Fort Dr. Manassas, VA 20110 daughter c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECO'S VALUE OF account number or similar identifying number. NUMBER TENANT JOINT Attach deed for jointly-held reai estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 A&B 02/28/95 Orrstown Bank, chk. acct. 1,205.06 33.33% 401.69 no. 405817 2 A&B 11/29/99 Orrstown Bank, CD5060063997 118,617.20 33.33% 39,539.07 3 A&B 01/24/94 Waypoint Bank, sav. acct. no. 50250075 4,273.02 33.33% 1,424.34 4 A&B 08/03/94 Waypoint Bank, CD no. 8000006382 87,550.22 33.33% 29,183.41 5 A&B 09/24/99 Waypoint Bank, CD no. 80000054635 22,097.48 33.33% 7,365.83 6 A&B 12/15/93 Waypont Bank, checking act. no 90845453 1,196.10 33.33% 398.70 7 A&B 01/25/99 Cornerstone FCU, savings acct. no. 6843-01 4,409.63 33.33% 1,469.88 8 A&B 01/25/99 Cornerstone FCU, CD acct. no. 6843-10 40,080.40 33.33% 13,360.13 TOTAL (Also enter on line 6, Recapitulation) $ 93,143.05 T (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software oniy CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Antoinette Williams Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SS# 178-28-1483 06/11/2001 FILE NUMBER 21-01-0840 DESCRIPTION AMOUNT FUNERAL EXPENSES: Joseph W. Scotchlas Funeral Home Catholic Cemeteries, grave opening St. Rose Church, engraving St. Patrick's Church, clergy and organist St. Michael's Church, clergy and organist Five Oaks Flor.al Shoppe, funeral flowers Ben-Mar Restaurant, funeral luncheon 7,017.00 245.00 206.00 150.00 125.00 386.90 707.25 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees Saidis, Shuff, Flower & Lindsay Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 2,640.00 4. Register of Wills 255.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs Cumberland Law Journal, estate advertisement The Sentinel, estate advertisement Costs incurred in sale of real estate: realtor's commission 5,400.00 transfer taxes 1,080.00 cert. fee 35.00 water and sewer bill 123.20 (credit for pro-rated taxes 827.66) Rowe's Antiques, appraisal fee 5,810.54 85.00 75.00 119.75 TOTAL (Also enter on line 9, Recapitulation) $ 17,822.44 (If more space is needed. insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1511 EX (Rev, 1-97) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Antoinette Williams SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSft 178-28-1483 06/11/2001 FILE NUMBER 21-01-0840 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 DESCRIPTION AMOUNT 24.02 105.06 99.00 221.28 204.00 Comcast cable bill Sprint, phone bill S. Middleton Township, water and sewer PPL Strawberry Court Condo, maintenance fee TOTAL (Also enter on line 10, Recapitulation) $ 653.36 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Antoinette Williams SCHEDULE J BENEFICIAR IES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions. and transfers under Sec. 9116(aXl.Z)] 1 Lillian P. Rowland daughter 1/2 of estate 205 Acre Dr. (j oint owner Carlisle, PA 17013 on bank accts.) 2 Joann M. Para daughter 1/2 of estate 8812 Fort Dr. (joint owner Manassas, VA 20110 on bank accts.) ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 SS# 178-28-1483 06/11/2001 FILE NUMBER 21-01-0840 (It more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) jE',tst 3JOill altb m~;GtrttttCltt OF ANTOINETTE WILLIAMS a/k/a JENNIE R. WILLIAMS I, Antoinette Williams a/k/a Jennie R. Hilliams, of 603 Reservoir Street, Simp~on, Lackawanna County, Pennsylvania, being at sound mind and body, declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils. ~' I HS '1' : direct the payment of all of my just debts, funeral and t.est,amen.tary expenses as soon as conv'enient after my decease. SECOND: I give, devise and bequeath all of my property, both real and personal, in equal per stirpes shares, to Lillian P. Rowland and Joann H. Para. However, it is also my expressed desire that both of the heirs give an equal monetary amount to each of my grandchildren as a token at my love tor each of them. 11'HI HI): 1 appoint Lillian P. Ho~rJand and Joann M. Para as Co-Executrices and I direct that they not be required to post bond. 1 further direct that in the case of specific devises and/or bequests, any inheritance tax due on said specific bequest shall be the responsibility of said belleficiary and shall not be paid from the residuary account. l:'ur:ther, I specifically all realty the named authorize that may and empO\'ler lIlY executor t.o convey any and be devised and distribute the proceeds to beneficiary and/or beneficiaries. This does not exclude said executor from devlsing the realty to the named beneficiary but allows him extra discretionary power to convey and/or sell. Commonwealth of Pennsylvania County of I, Antoinette \'1 i 11 i am s , a/k/a Jennie R. Williams, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. (<,;- - I ',--1-' ~ll /: /J // ~ A ~ ) ~~,~..:::J!...4~<<' --;J ANTOINETTE WILLIAMS alkla (~ ../~).' '7 ~ . \ (- --w)A/L-t' .-/.?~ \'/ILLIAHS Sworn or affirmed to and acknowledged before me by Antoinette -+h Williams, alkla Jennie R. Williams, Testatrix, this \D day of rY\lHC h , 1993 ~~~~~ I _~~O~~ ~uvc~ :lE::;~~,~~NO~'A:Y a:~BLIC ~ ~<- ' \~ e , the Witnesses, whose names are signed to the attached or instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~~h,C{\~ "IT7v/~' \H'l'NESS Sworn or '\(firmed to and subscribed to b\fore me by the above Witnesses, ~----n.!'l~ m~:Lu-c.-o and ha.-vlcL r~ltlnw ~h h^ ~ this.-lLday of _~ t \oJLch , 993. NOlarialS;;--- QRI'L~~~ Donna Shema, NoIafy Public NO'}' A R Y PUB L I C Forest CIty Bora. St.Iscjuehama County My Commssloll Expros Aptft 27. 100$ r, PennSYlVania Association 0 -H\ IN \H'l'NESS \'IHEREOF, I hereunto set my hand and seal this It! day of m ill\(l\ Nineteen Hundred and Ninety Three ( 1993) . c? t~~dez-W~e.<-C~t~ ANTOINETTE WILLIAMS ~a(k/a_/_) . /' :~~LL~~--z~~ (f NNIE R. WILLIAMS SIGNED, SEALED, PUBLISHED AND DECLARED by Antoinette Williams a/k/a Jennie R. Williams, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses: ~L2i{' ~, ..R~SIDING A'f _ILL, 1hul~.L.L~ t '^- _ ~:Y~^_R"SIDING A'r_d/~/ /' o~ . RRSTOWN BANK TO: Said is, Shuff, Flower & Lindsay 2109 Market Street Camp Hill, PA 17011 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Jennie Williams DECEASED DATE OF DEATH: June 11,2001 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOllOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST 405817 Jennie Williams 02-28-95 1,204.84 .22 Lillian P. Rowland Joann M. Para (2) SAVINGS ACCOUNTS DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST 5060063997 Jennie Williams 11-29-99 118,294.34 322.86 Lillian P. Rowland Joann M. Para Date: 08-07-01 By: Wendy Bullock PO Box 250. Shippensburg, PA 17257 · (717) 532-6114 · (717) 532-4143 Fax · www.orrstown.com ...: 'l~ t'A.\. l[4H1SlU1S Cornerstone FC 14J 002 CORNERSTONE ~ Federal Credit Union Member founded - Service based P.O. Box 1181, 5 East Gate Drive, Carlisle, PA 17013 Telephone (71 7) 249-1661 FAX (717) 24~1-8208 August 6, 2001 Saidis, Shuff, Flower & Lindsay 2109 Market Street Camp Hill, PA 17011 RE: Jenr:.e Williams Accounts S.S. iH 78-28-1483 Dear Attorney Flowers: Per your letter I am providing the following account information on the a hove referenced member. Ms. Williams opened an account with our credit union on 1/25/99 in her name with Lillian Rowla:ld and Joann Para listed as Joint Owners. The following is her account information: Account Type Account Number Balance 6/11/01 Interest Ear fled Total Savings Certificate 6843-01 6843-10 $ 4,385.44 $40,019.55 $24.19 $60.85 $ 4,409.63 $40,080.40 There have been no changes in the account status since it was opened ard the member did not haue any loans with our credit union. Please call if you require additional information. A;; 1 / "illcen.. r ( ci~t Q~3 (j Carolyn . Gantz Opera! ions Representative MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO $100,000 BY THE NATlONJ,L CREDIT UNION ADMINlSTRATION ~IWay~qi!1J LOOK FOR US. WE'LL GET YOU THERE. 08/03/2001 SAIDIS SHUFF FLOWER & LINDSAY 2109 MARKET ST CAMP HILL PA 17011 The information which you requested on the account(s) of JENNIE WILLIAMS DECEASED (Social Security Number 178-28-1483) is/are as follows: Account Number 50250075 8000006382 8000054635 90845453 Class of Account SA VINGS CERTIFICA TE CERTIFICA TE CHECKING Date Opened 01/24/94 08/03/94 09/24/99 12/15/93 Principal Balance 4270.70 87410.36 22062.18 1196.01 Accrued Interest 2.32 139.86 35.30 .09 Balance at Date of 4273.02 87550.22 22097.48 1196.10 Death Account Ownership !TO no no no //LILLIAN ~ \ .--- . Name of Joint LILLIAN /LILLIAN LILLIAN Owner, if any ! ROWLAND/ ROWLAND RO~AND ROWLANo/ ---~.- - - --------- Date Ownership --~-,~---- 01/24/94 08/03/94 (J9i24/99 12115/93 Was Estabr!ed A U JTO JOANN PARA ON FOUR ACCOUNTS Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested Sincerely, .P t7 f(tUlt "" - ' KATHY~OUN SENIOR SERVICES REP. P.O, Box 1711, HARRISBURG. PeNNSYlVANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com B:t ROWE:1~~:t 08 . AU 2276L R. D. 4, Box 353 . Carlisle, P A 249-2677 249-1978 Auction Is Action Call "ROWE"Por Satisfaction July 24, 2001 TO: Lillian P. Rowland Executrix 205 Acre Drive Carlisle, Pa. 17013 COPY: James Flower, Jr. Attorney 26 West High Street Carlisle, Pa. 17013 FROM: Benny E. Rowe Appraiser/Auctioneer 2505 Ritner Highway Carlislej Pa. 17013 REF: Jennie Williams estate, 48 Strawberry Drive,Carlisle, Pa. Personal Property Appraisal at current Auctuion Market Value. . ' PAGE 2 DINING/KITCHEN Oak Table w/4 Chairs Oak 2 Pc. Hutch Cupboard R C A Portable T V Glass/China Decorators/Accessories Pots/Pans/Baking Small Electrical Appliances Small Kitchen Accessories 2 Door Cabinet $ 85.00 125.00 20.00 55.00 40 .00 32 .00 24.00 20.00 14.00 BEDROOM !l 5 Pes. Cherry Bedroom Suite 8 Drawer Jewelry Chest Table Lights Cedar Chest Bedding Upholstered Arm Chair Pedestal Pictures/Prints Accessories/Decorators 285.00 45.00 8.00 20.00 5.00 5.00 12.00 6.00 18.00 BEDROOM 1!.. ~ 3 Pes. Bedroom Suite 2 Tier Stand Gossip Bench Table Light Mirror/Prints Accessories/Decorators 140.00 20.00 12.00 4.00 10.00 15.00 PAGE 3 LIVING ROOM Sofa & Love Seat Platform Rocker w/Hassoek 3 Pes. Coffee & End Stands Color T V Upholstered Arm Chair Hall Table Stand Side Chair Corner Curio cabinet Gilt Mirror Knee Hole Desk Pictures/Prints Figurines Decorators $ 165.00 35 .00 30.00 35 .00 8.00 20.00 8.00 4.00 75 .00 10.00 75 .00 'J 2.00 18.00 32 . 00 TOTAL $1547.00 ('-:/ " \) '.",.,) ..:...:_--__. "1-- '-.[~~ Benny E. Rowe -----.. 2---. , . r( ) 1. FHA Settlement Stalement . U. S. Department 01 Housin and Urban Development Form US HUD . 1 Paoe No. 1 I ) 2. FmHA 6. File Number AE 1664 7. Loan Number 8. Mortgage Insurance ( 1 3. Cony. Unins. Case Number ( ) 4. VA ( ) 5. Cony. Ins. D. Name and Address at Borrower: E. Name and Address 01 Seller. C. This form is furnIshed to give you a statement 01 actual senlement costs. Amounts paId 10 and by the settlement agent are shown. Items marked '(p.o.c.)' were paid oulslde of the closin : the are Shown here for informational u oses and are not included in the totals. WILLIAM Z. LEAPHART IRENE M. LEAPHAR'l' 7 00 WES'l' PENN STREET CARLISLE, PA 17013 ESTATE OF Jl!:NNJ:E BY EXECO'l'RIXES: R. WILLIAMS LILLIAM P. ROWLAND JOANN M. PARA ATTORNEY OF ESTATE: JAMES D. FLOWER, JR. TIN G. Property Lacallon 48 STRAWBERRY DJUVE, CARLISLE SOU'l'H MIDDLE'l'ON TOWNSHIP, CUMBERLAND COUNTY PARCEL NO.: 40-23-0600-012 F. Name and Address 01 Lender H. SeUefs Settlement Agent FREY r. TILEY 5 South Hanover St. Carlisle, PA 17013 Settfement Date: Place of Settfement: October 22, 2001 5 SOU'l'H HANOVER STREET 10:00 A.M. CARLISLE, PENNSYLVANIA 500 5,000.00 501 Excess deposit (see instructions) 0.00 502 Senlement charges to seller (line 1400) 6,638.20 503 Exisllng loan(s) taken subject to 504 Payoff 01 lirst mortgage loan 505 Payotl of second mortgage loan 506 507 508 509 Adjustmenls for items upaid by seller 510 City/town laxes to: 511 County taxes to: 512 Assessments to: 513 514 TIN 25-1730538 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100 :: :...:x.::.......<x; 400 101 Contract sales price 108,000.00 401 Contract Sales price 102 Personal property 402 Personal property 103 Settlement cMarges Irom (line 1400) 1,675.50 403 104 404 105 405 Adjustments (or items paid by seller in advance: Adjustments for ;rams paid by seller in advance: 106 City/town taxes 10: 406 City/town taxes to: 107 County taxes to: 407 County taxes to: , 108 Assessments to: 408 Assessments to: 109 Tax Pro-Ration to Octnbet 2.2. 200 J 794.76 409 Tax Pro-Ration to Octnber Z2, 2001 110 111 OCTOBER DUES PRORATION-PAID$102 112 410 32.90 411 OCTOBER DUES PRORA'l'ION-PAID$102 412 110,503.16 420 Gross Amount Due 10 Seller 120 Gross Amount Due From Borrower -------------- -------------- 200 AmounlsPaidByOrln Behalf Of Borrower '" 201 Deposit or earnest money 202 Principal amount at new loan{s) 203 Existing loan(sllaken SUOtecl to 204 205 206 207 208 209 Adjustments for items upsJd by seJJer 210 City/town taxes :0: 211 County taxes to: 212 Assessments 10: 213 214 215 216 217 218 219 220 Total Paid By/For Borrower 515 516 517 518 519 5, 000. 00 520 Total Reductions to Amt Due Seller 300 .' 600 601 Gross amount to seller Irom (fine 420) 602 Less reductions in amount due seller (from line 520): 603 Cash ( ) From (X) To Seller .;. . - ." . . . .... 301 Gross amount due from borrower (line 120) 302 Less amounts paid bylfor borrower (from fine 220) 303 Cash (X) From ( ) To Borrower 110,503.16 (5,000.00) 105,503.16 --- 108,000.00 794.76 32.90 108,827.66 ------------- -------------- 6,638.20 ------------ -------------- 108,827.66 (6,638.20) 102,189.46 -------------- ------------ - . HUQ.l L SETTLEMeNT CHARGES Page No. 2 Paid From tzQ!l Seller's Funds at 701 Settlement 702 703 5,400.00 704 705 801 802 803 804 805 806 807 808 3 810 811 901 902 903 904 905 '~~'''!;:i,;:, 1990 1001 1002 1003 1004 1005 1006 1007 1008 1100 1101 1102 1103 1104 1105 1106 P.O.C. 1107 1108 1109 1110 1111 1112 1113 7.00' .Total SaleslBroker's.Comm;basi!d;oit!Rri~~;;;.2J;i lOa. 000.00 Division 01 Commission (fine 700) as loi/ows: 701 5,400.00 to a-ll AGENCY GKAC REAL ES'l'A'l'Z 702 to 703 704 Commission paid at Settlement 705 801 Loan Origination Fee 802 Loan Discount 803 Appraisal Fee 804 Credit Report 805 Lenders Inspection Fee 806 Mortgage Insurance Application Fee 807 Assumption Fee 808 B09 810 811 901 Interest From 902 Mortgage Insurance Premium for 903 Hazard Insurance Premium for 904 905 1001 Hazard insurance 1002 Mongage insurance 1003 City property taxes 1004 County property taxes 1005 Annual assessments 1006 1007 School taxes 100a 1101 Settlement or closing tee 1102 Abstract or title search 1103 TiUe examination 1104 Title insurance binder 111lS Document preparation 1 106 Notal'! fees 1107 Attorney's fees {includes above items numbers: 1108 nile Insurance {includes above items numbers: 1109 Lenders Coverage 1110 Owners Coverage 1111 1112 1113 1201 Recording lees: 1202 City/county/slamps: 1203 Slate laxlstamps: 1204 1205 ~ 5% . S, 400.00 Paid From Borrowers Funds at Settlement (Mortgage Amt .00 % .00 % 0.00) 0.00 0.00 to 10 10 to to to months to years to years to mos. @ mos. @ mos. @ mos. @ , mos. @ mos. @ mos. @ mos. @ per day -= per month per month per month per month per month per month per month to 10 to to \0 10 to FREY " 'rILEY/SAID:IS, SIlt1FP. !'LOWER .. LINDSAY 500.00 to Closing SelV1ce Letter (Frey & Tiley tor Comwlth. Land Title) SO S108,000 Deed $25.50 Deed $1.,080.00 Deed $1,080.00 Releases 1 30 1 Survey 10 1302 Pest inspeclion to 1303 Current Taxes due from Borrower/Seller Mortgage: Mortgage: $ Mortgage: $ 25.50 1201 1,080.00 1202 1,080.00 1203 1204 1205 1.300 1301 1302 1303 70.00 1304 123.20 1305 35.00 1306 N/A 1307 1,675.50 6,638.20 --==-===-=-:::- --:::::z======== 1304 WOOD INFESTATION FEE TO GILBERTS 1305 FINAL WATER AND SEWER BILL TO SMTMA - ACCT NO.: 010142 1306 RESALE CERTU'ICATE FEE TO PROPERTY MANAGEMENT, INC. 1307 INIATION FEE TO PROPERTY MANAG~, INC. 03'; I~UD-1 Page No. 31 CERTIFICATION I direct and authorize the Compnay to make distributions indicated for my account on the attached HUD-1 Settlement Statement, approving the tax prorations indicated therein, and understand that prorations were based on figures for the preceding year, or estimates for the current year, and in the event of any change for 1he current year, aU necessary adjustments must be made between Seller and Borrower direcl; likewise any DEFICIT in delinquent taxes will be reimbursed to Attomeymtle by Seller. I have carefully reviewed the HUD-1 Settlement Statement and to the besl of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify thaI I have received a copy of the HUD-1 Settlement Statement. dd~9 , '~ ~' , . ." ~ . -X~~Jr; "=-,, )v ",..9 Q~~~ " ----. v~ To the best of my knOWledge, the HUD-1 Settlement Statement which r have prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. {)c/o6 ~ z 2 ? 00 I ) Dale WARNING: II is a crime to knowingly make false statements imprisonment. For details see: Tille 18 U.S. Code Section 1 D the U ited States on this or any olher similar form. Penalties upon conviction can include fine and Section 1010. INFORMATION1:lEPORTING ON REAL ESTATE TRANSACTIONS THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H. I. M AND LINE 401) AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. IF YOU ARE REOUIRED TO ALE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED. Solicitation of TIN Seller is required by law to provide the Attomey/Company with hislher correct taxpayer identification number. If correct taxpayer identification number is not provided. he/she may be subject to civil or criminal penallies imposed by law_ Certification of TIM Under penalties of pe~ury, I certify that the taxpayer identification number shown in this statement is my correct taxpayer identification number. Seller Seller TAX PRO.RATION ADDENDUM Date Qf Pro-Ration: Borrower Seller ASSESSMENT: 5105,620,00 5105,620.00 2001.2002 5chool Real Eslale Tax 2001-2002 School Real Estate Tax- Face 2001-2002 School Real Eslale Tax. Per Day 252 Days Pre-paid = 10.6 mills 51,119,57 $3.05893 5nO.85 P,Q,C. October 22, 2001 See Settlement Sneel Lines Numbers 110, 410 and 1303 for Results of In is Addendum. 2001 Co, & TwpJ6or. Real Eslate Tax 2001 Co. & TwpJ6or. Real Estate Tax- Face 2001 Co. & Twp./60r. Real Eslal. Tax- Per Day 71 Days Pre. paid = 1.9532 mills 5206.30 $0,56521 $40.13 P,Q.C, Purchaser owes: Lass 2%,. discount no,a5 40.13 810.98 16,22 794,76 252 Days pr.-paid School Plus 71 Days Pre.paid Co, & Twp./60r.